Bacterial etiology of urinary tract infections in patients treated at Kenyan health facilities and their resistance towards commonly used antibiotics

Abstract

Background Evidence-based empirical antibiotic prescribing requires knowledge of local antimicrobial resistance patterns. The spectrum of pathogens and their susceptibility strongly influences guidelines for empirical therapies for urinary tract infections (UTI) management. Objective This study aimed to determine the prevalence of UTI causative bacteria and their corresponding antibiotic resistance profiles in three counties of Kenya. Such data could be used to determine the optimal empirical therapy. Methods In this cross-sectional study, urine samples were collected from patients who presented with symptoms suggestive of UTI in the following healthcare facilities; Kenyatta National Hospital, Kiambu Hospital, Mbagathi, Makueni, Nanyuki, Centre for Microbiology Research, and Mukuru Health Centres. Urine cultures were done on Cystine Lactose Electrolyte Deficient (CLED) to isolate UTI bacterial etiologies, while antibiotic sensitivity testing was done using the Kirby-Bauer disk diffusion using CLSI guidelines and interpretive criteria. Results A total of 1,027(54%) uropathogens were isolated from the urine samples of 1898 participants. Staphylococcus spp. and Escherichia coli were the main uropathogens at 37.6% and 30.9%, respectively. The percentage resistance to commonly used drugs for the treatment of UTI were as follows: trimethoprim (64%), sulfamethoxazole (57%), nalidixic acid(57%), ciprofloxacin (27%), amoxicillin-clavulanic acid (5%), and nitrofurantoin (9%) and cefixime (9%). Resistance rates to broad-spectrum antimicrobials, such as ceftazidime, gentamicin, and ceftriaxone, were 15%, 14%, and 11%, respectively. Additionally, the proportion of Multidrug-resistant (MDR) bacteria was 66%. Conclusion High resistance rates toward fluoroquinolones, sulfamethoxazole, and trimethoprim were reported. These antibiotics are commonly used drugs as they are inexpensive and readily available. Based on these findings, more robust standardised surveillance is needed to confirm the patterns observed while recognising the potential impact of sampling biases on observed resistance rates.

Patterns and trends of antimicrobial resistance in bacterial isolates from urine cultures in Eritrea, 2010–2021: a secondary dataset analysis

“…On the basis of the latter and other considerations; existence of ESBL, XDR)/or PDR pathogens in this setting cannot be overruled. Overall, our data align with multiple reports from the region [36,20,19]. In the past, experts have argued that a MAR >-2 originates from an ecological environment characterized by uncontrolled use of broad spectrum antibiotics [37].…”

“…The median age (mainly females) in Namibia was 28 and 32 years [18]. Similar pro les in other countries were as follows: Kenya 30.7 (±12.1) years and 81.5% women [19]; and Ghana: 30 (±28) years and 66.1% females [20]. The skew toward elderly male patients highlights differences in clinical practice in settings across SSA.…”

“…In Kliebsiella spp. The proportions were 10.7% vs 8.9% in Kenya [19]; 11.4% in Ethiopia [22]; 6.3% in Namibia [18], among others. Similar to other studies, the order and frequency of other commonly isolated uropathogens was different from what has been reported elsewhere [19,20].…”

“…Although marginally lower, the prevalence of UPEC was within the 35% -60% range reported in the region. For example, UPEC was 39.7% vs 30.9% in Kenya [19]; 57.2% in DRC Congo [21]; 37.7% in Ethiopia, Gondar [22]; 40.7% in Namibia [18]. In Kliebsiella spp.…”

The Antimicrobial Resistance (AMR) Rates of Enterobacterales in a Rural Hospital from the Eastern Region, Ghana: A Retrospective Study, 2022

“…Previous similar studies have also reported a link between bacterial infections in urine and factors such as residing in rural areas, being uncircumcised, and experiencing frequent urination, which could be more prevalent in older age groups. Additionally, the frequency of resistance in urinary tract infections is higher due to patients often receiving prescribed antibiotics and self-administering them without supervision, particularly in regions where self-medication practices are common [ 35 , 36 , 37 ].…”